Health Sciences

Introduction: Bipolar disorder (BD) is a chronically progressive mental condition, associated with a reduced quality of life and greater disability. Patient admissions are preventable events with a considerable impact on global functioning and social adjustment. While machine learning (ML) approaches have proven prediction ability in other diseases, little is known about their utility to predict patient admissions in this pathology. Aim: To develop prediction models for hospital admission/readmission within 5 years of diagnosis in patients with BD using ML techniques. The study utilized data from patients diagnosed with BD in a major healthcare organization in Colombia. Candidate predictors were selected from Electronic Health Records (EHRs) and included sociodemographic and clinical variables. ML algorithms, including Decision Trees, Random Forests, Logistic Regressions, and Support Vector Machines, were used to predict patient admission or readmission. Survival models, including a penalized Cox Model and Random Survival Forest, were used to predict time to admission and first readmission. Model performance was evaluated using accuracy, precision, recall, F1 score, area under the receiver operating characteristic curve (AUC) and concordance index. The admission dataset included 2,726 BD patients, with 354 admissions, while the readmission dataset included 352 patients, with almost half being readmitted. The best-performing model for predicting admission was the Random Forest, with an accuracy score of 0.951 and an AUC of 0.98. The variables with the greatest predictive power in the Recursive Feature Elimination (RFE) importance analysis were the number of psychiatric emergency visits, the number of outpatient follow-up appointments and age. Survival models showed similar results, with the Random Survival Forest performing best, achieving an AUC of 0.95. However, the prediction models for patient readmission had poorer

Background: The end of 2019 marked the beginning of the global pandemic COVID-19. With this global issue, all the fields of society became stagnant. The education system is no exception to it. Education sector suffered as students were sent back to homes and schools, colleges and universities were shut down. But steps were taken and the education teaching system was shifted from offline to online mode. This research project examines the educational pedagogy which has been adapted in online mode of teaching due to post COVID-19 lockdown. It seeks to discover the pros and cons of online teaching vis-a-vis the ways of offline conduct of classes. The data for the project has been gathered in the form of an online survey in which both teachers and students were given questionnaires which are used to map and understand different pedagogical choices during online teaching. It also tries to highlight the comparative value, compatibility and usefulness of digital mode of learning. 

The research presented was motivated by the need to understand the representations of human beings in their identified genders mainly during adolescence as an important stage of life. However, the work is also motivated by understanding the representations of the human being in other phases of life. The genres with their recognized categories and descriptors were operationalized through the following lexical elements added mainly in English due to the search engine (Google Books through association with Brigham Young University) used assuming that language as the search standard. At the same time, the scanning will be carried out in Brazilian Portuguese in the corresponding search engine called Brazilian Corpus made available by the Linguateca initiative 1 . Therefore, these are the genders collected for the research: male, female, gay, lesbian, homosexual, transgender people; person, transgender, transgender person, transsexual person, two-spirit person, transgender person, transgender person, transsexual person, transgender two-spirit transsexual, gender queer, gender dysphoria, gender identity, gender diverse, gender non-conforming minors, non-conforming gender-conforming, gender-affirming, non-binary; nonbinary; cross gender, gender diverse, nonconforming teen, LGBTQ, nonconforming person, gender minority, gender transition, family, adopted family, (as well as its appropriate plural forms due to the analysis that shows differences between the representations around the singular form and the plural form of the term). As stages of life, they were, therefore, operationalized through the following lexical 1 Access to Linguateca is through the address: Access to bodies: Brazilian Corpus (linguateca.pt).

Abstract: Variations in protein, lipid, carbohydrate and astaxanthin content of Enteromorpha intestinalis, Ulva lactuca and Catenella repens were documented over a 10 months period from September 2007 to June 2008. The macroalgal species were collected from six sampling stations of Indian Sundarbans, a Gangetic delta at the apex of Bay of Bengal. On dry weight basis, the protein content varied from 4.15±0.02%(in Catenella repens) at Lothian to 14.19±0.09%(in Catenella repens) at Frasergaunge. The lipid content was low and ...

Streszczenie: Starzenie się człowieka jest procesem nieuniknionym, nieodwracalnym i dotyczy każdego z nas. Podejmowane są wszelkiego rodzaju działania zmierzające do przedłużenia sprawności psychofizycznej i wydłużenia czasu trwania starości. Celem niniejszego doniesienia było określenie stopnia uczestnictwa osób starszych w czasie wolnym, z uwzględnieniem udziału w rekreacji ruchowej. Podjęto również próbę wskazania motywów i barier w podejmowaniu przez respondentów aktywnych form wypoczynku. W pracy wykorzystano metodę sondażu diagnostycznego, a narzędziem badawczym był autorski kwestionariusz ankiety. Wyniki badań wskazały, iż osoby starsze preferują aktywne formy spędzania czasu wolnego. Najczęściej wybierają jazdę rowerem, nordic walking i pływanie. Motywem zachęcającym do podejmowania aktywności fizycznej jest przede wszystkim dbałość o własne zdrowie. Respondenci dostrzegają brak klubów seniora, gdzie mogliby ciekawie spędzić swój wolny czas. Propozycją właściwego wykorzystania dosyć znacznego budżetu czasu wolnego tej grupy społecznej jest organizowanie prostych form aktywności fizycznej, względnie blisko miejsca zamieszkania, w których towarzyszyliby znajomi lub członkowie rodziny.

Anterior open bite affects the child population by approximately 20%, with great aesthetic-functional impairment due to dental-skeletal changes, which may involve the presence of posterior crossbite. The objective was to present the anterior open bite correction associated with posterior crossbite with the use of a removable palatal crib. Patient during the mixed dentition phase presented an anterior open bite caused by a pacifier sucking habit and secondary lingual interposition. The treatment protocol consisted of the use of removable expander with palatal crib and nocturnal use of the chincup. The anterior open bite was corrected, and the best transverse relation of the arches was obtained. The precocious treatment using the palatal crib associated to the chincup allows to achieve favorable results in the resolution of the anterior open bite.

Orthodontic-surgical treatment with the “Surgery First Approach” provides immediate facial aesthetic improvements and significantly reduces the patient's orthodontic treatment time, avoiding the transient worsening of the facial profile due to dental decompensation that occurs in surgical cases. Thus, this clinical case describes the retreatment of a 22-year-old female leukoderma patient, whose main complaint was related to the proclination of upper and lower incisors. The patient used a mio-relaxing plate for 30 days, which evidenced the skeletal mandibular deficiency and the ½ bilateral Class II malocclusion. Orthognathic surgery first approach associated with the extraction of the 4 premolars was chosen considering the patient’s aesthetic demand. The use of a mio-relaxing plate in the diagnostic stage was essential for the real diagnosis of mandibular deficiency and the technique employed made it possible to conclude the treatment avoiding aesthetic commitment, with excellent...

Anterior open bite affects the child population by approximately 20%, with great aesthetic-functional impairment due to dental-skeletal changes, which may involve the presence of posterior crossbite. The objective was to present the anterior open bite correction associated with posterior crossbite with the use of a removable palatal crib. Patient during the mixed dentition phase presented an anterior open bite caused by a pacifier sucking habit and secondary lingual interposition. The treatment protocol consisted of the use of removable expander with palatal crib and nocturnal use of the chincup. The anterior open bite was corrected, and the best transverse relation of the arches was obtained. The precocious treatment using the palatal crib associated to the chincup allows to achieve favorable results in the resolution of the anterior open bite. Keywords: Open Bite. Malocclusion. Orthodontics, Interceptive. ResumoA mordida aberta anterior acomete a população infantil em aproximadame...

Métodos: Para la implantación celular se emplearon células mononucleares de la médula ósea y también las movilizadas con Filgrastim a la sangre periférica. Las plaquetas se usaron en forma de plasma rico en plaquetas o de lisado plaquetario. Se incluyeron los pacientes con diferentes enfermedades vasculares atendidos en instituciones del país en el período 2004-2015. Resultados: Con la terapia celular se obtuvo resultados favorables en pacientes con isquemia crítica de miembros inferiores, claudicación intermitente, tromboangeítis obliterante, pie diabético, síndrome posflebítico y linfedema de miembros inferiores. Con el uso de las plaquetas se obtuvieron resultados prometedores en pacientes claudicantes, con pie diabético y úlceras posflebíticas.

The Neural Gas Networks (NGN) is considered one of the most and popular algorithms in most researches. It is considered the fastest neural and it is more practical such as the other neural methods. Recently, it has achieved the fast and best result in a lot of researches. In this paper, we propose NGN to extract the features of brain cancer detection and then we are classifying the features by using Adaptive Neuro Fuzzy Inference system (ANFIS). Actually, this method consists of two main parts, the first part is the segmentation process using K-means cluster and the second part is based on extracting features from MRI cancer brain images based on NGN. After that, we applied Adaptive Neuro Fuzzy Inference System (ANFIS) for classification and prediction. Finally, the ANFIS method achieved accuracy from 85% up to 96%.

Head and neck cancer (HNC) appears with one of the most recurring sites of cancer, and the percentage of metastases is also high in both localized region and distant areas. Diagnosis of metastases is correlated with poor prognosis, with a median survival of about 10 months. Therefore, early diagnosis is of utmost significance in the treatment of HNC. Metabolomics study targeting altered metabolic pathways exhibits a promising approach for discovering early novel noninvasive targets and biomarkers in HNC lymph node metastasis. An increased level of Lactate dehydrogenase (LDH) has been observed as a major diagnostic metabolomics biomarker for poor survival among HNC patients. It is also recommended as a more efficient biomarker of metastasis. For present study serum samples were collected from healthy controls (n=10) and HNC patients with and without lymph node metastasis (n=10 each). Prepared serum samples were analyzed by UV-spectrophotometer. Further, obtained data were analyzed us...

Cultural misappropriation in modern Yoga arises when its deep spiritual and cultural roots are stripped away, reducing it to a mere fitness routine or commodity. This paper explores the distinction between misappropriation and appreciation, highlighting the importance of respecting Yoga's Samskrut terminology, sacred symbols, and traditional practices. True cultural appreciation involves sincere engagement, reverence for its origins, and acknowledgment of its Indian context. Misrepresentation and commodification dilute Yoga's essence, while authenticity lies in practicing and teaching with integrity and respect. By addressing these issues mindfully, the Yoga community can preserve its universal values while honouring its cultural heritage.

Halal is a dietary guideline practised by Muslims. Halal is viewed as a seal of approval for food quality that cannot be easily verified by consumers prior to, during, or after eating. As a result, Halal certification serves as a useful tool for consumers to make educated purchasing decisions. Halal food and beverage supply chains relate to the process of managing halal food and beverage items from manufacturing to consumption, involving multiple partners in the SC networks. This study examines the significance of Halal Food Supply Chain features in the UAE market, as well as consumer trust and satisfaction. This study examined the supply chain in the United Arab Emirates, with an eye toward the future impact of HFC systems on customer perceptions of halal food practices.

While health service utilization is a key indicator of health service delivery which many countries seek to improve, low health service utilization patterns characterize many urban settings in developing countries with a grave impact on the community. One such urban setting is Mbale Municipality in Mbale district, Uganda. A cross sectional descriptive study was carried in five wards of Mbale Municipality on the ninety-three ( ) respondents. The study aimed at investigating the determinants which influence utilization of health services in urban areas. The information was collected using questionnaires and semi structured interviews. The study findings showed that the procurement process resulted in delayed and inadequate supply of essential drugs and medical equipment' supply. Understaffing is high and untimely funding was also reported. Poor medical ethic or code of conduct of the health workers and negative perceptions of the community towards health services and health staff were cited as other influencing determinants to health services utilization in urban areas. In view of these findings, the authors propose a review of the procurement system to ensure timely and adequate supply of drugs and medical equipment, recruitment of more health staff, continuous professional development (CPD) of health workers in medical ethical code of conduct in handling patients, sensitization of the community to build trust on health workers, and sharing of responsibilities by couples while taking care of patients in admission.

Pharmacist attitudes about the over-the-counter (OTC) sale of HIV rapid tests in pharmacies were explored through interviews conducted among 17 licensed community pharmacists in a Midwestern, moderate HIV incidence state between May and September 2012. Participants recognized that OTC rapid HIV tests would increase the number of people aware of their HIV status. Concerns included linkage to care and results consultation for those who test HIV-positive. Point of sale was identified as an opportunity for consultation about the test and to establish a relationship for future discussion about results and linkage to care. Pharmacists could provide initial test consultation or information, and consultation about the test results in order to provide post diagnosis support and facilitate linkage to care. Las actitudes de los farmacéuticos sobre el over-the-counter (OTC) venta de las pruebas rápidas del VIH en farmacias se exploró a través de entrevistas entre los 17 farmacéuticos comunitarios con licencia en un estado del Midwestern en Estados Unidos, moderado incidencia del VIH entre Mayo y Septiembre de 2012. Los participantes reconocieron que OTC pruebas rápidas de VIH aumentaría el número de personas que conocen su estado serológico. Las preocupaciones incluyen la vinculación con cuidado y consulta los resultados para los que el resultado es VIH-positivo. Point of sale de venta fue identificado como una oportunidad de consulta sobre la prueba y establecer una relación para un discussion futuro sobre los resultados y la vinculación a la atención. Los farmacéuticos podría ofrecer consulta inicial de prueba o información y consulta sobre los resultados de la prueba con el fin de ofrecer apoyo después de diagnóstico y facilitar la vinculación a la atención.

Aims: Overweight and obesity are clinical public-health concerns worldwide. Amongst older adults, the prevalence of overweight and obesity is considered high. the purpose of this study was to provide current data regarding the prevalence and trends of overweight and obesity of adults from 2005 to 2013 in 10 European countries. Methods: the data used in the present study were derived from the first, second, fourth and fifth waves of the survey of Health, Ageing and Retirement in Europe. the present study includes individuals aged ≥50 years from 10 European countries. Body mass index (BMI) was calculated from self-reported height and weight (kg/m 2 ). Results: the general prevalence of overweight (BMI ≥25 kg/ m 2 ) was slightly above 60% and remained stable between 2005 (60.1%, 95% confidence interval (CI): 59.3-60.9%) and 2013 (60.3%, 95% CI: 59.7-60.9%). On the other hand, the prevalence of obesity (BMI ≥30 kg/m 2 ) increased significantly (1.6 points, 95% CI: 0.7-2.6) from 17.5% in 2005 to 19.2% in 2013. Although the prevalence of obesity increased in most countries, the only significant increase was observed in germany (5.8 points, 95% CI: 1.8-9.9). spain was the only country where the prevalence of obesity decreased significantly (-4.7 points, 95% CI: -8.8 to -0.5). sex and age differences are reported. Conclusions: Although the prevalence of overweight was stable, the prevalence of obesity rose. Based on the data currently available for Europe, the prevalence of obesity in European older adults has already reached epidemic proportions, which reinforces the need for the development of effective healthy lifestyle programs.

To examine the risk of mortality associated with interruptions to the continuity of methadone maintenance treatment (MMT), including transfers between services, in opioid-dependent individuals attending specialist addiction services. Design Retrospective cohort study using addiction services and primary care dispensing records, the National Methadone Register and National Drug-Related Death Index (NDRDI). Setting Geographically defined population in Dublin, Ireland. Participants A total of 2899 people prescribed and dispensed methadone in specialist addiction services between January 2010 and December 2015. There were five exposure groups: weeks 1-4 following transfer between treatment providers; weeks 1-4 out of treatment; weeks 5-52 out of treatment; weeks 1-4 of treatment initiation; and weeks 5+ of continuous treatment (reference category). Measurements Primary outcome: drug-related poisoning (DRP) deaths. Secondary outcome: all-cause mortality (ACM). Mortality rates calculated by dividing number of deaths (DRP; ACM) in exposure groups by person-years exposure. Unadjusted and adjusted Poisson regression (covariates age, sex, incarceration, methadone dose and comorbidities) estimated differences in mortality rates. Findings There were 154 ACM deaths, 55 (35.7%) identified as DRP deaths. No deaths were observed in the first month following transfer between treatment providers. The risk of DRP mortality was highest in weeks 1-4 out of treatment [adjusted relative risk (aRR = 4.04, 95% confidence interval (CI) = 1.43-11.43, P = 0.009] and weeks 1-4 of treatment initiation (ARR = 3.4, 95% CI = 1.2-9.64, P = 0.02). Similarly, risk of ACM was highest in weeks 1-4 out of treatment (ARR = 11.78, 95% CI = 7.73-17.94, P < 0.001), weeks 1-4 of treatment initiation (aRR = 5.11, 95% CI = 2.95-8.83, P < 0.001) and weeks 5-52 off treatment (aRR = 2.04, 95% CI = 1.2-3.47, P = 0.009). Conclusions Interruptions to the continuity of methadone maintenance treatment by treatment provider do not appear to be periods of risk for drug-related poisoning or all-cause mortality deaths. Risk of drug related poisoning and all-cause mortality deaths appears to be greatest during the first 4 weeks of treatment initiation/re-initiation and after treatment cessation.

Background: The 'perfect' journey through an Irish Methadone Maintenance Treatment Programme (MMTP) would have a client engage appropriately with all relevant services available to them, inclusive of psychiatry, counselling, out-reach support, nursing and psychology. Concurrently, a client would ideally adhere to their prescribed methadone-dosing regimen, until a client is stabilised allowing them to function optimally. At this point, a client should transfer to the GP community setting. Unfortunately, this fails to occur. To date, very few studies have specifically investigated the reasons why a cohort of clients remain 'trapped' in the high risk, specialist clinical setting. Methods: Qualitative detailed semi-structured interviews were undertaken with 17 clients of one of Ireland's Health Service Executive (HSE) Drug and Alcohol Services, entitled 'HSE Mid-West Limerick Drug and Alcohol Service'. Each client had a severe Opioid Use Disorder (OUD) and clients had spent on average 7.5 years engaging with the MMTP. Results: Participants' life journey prior to an OUD included Adverse Childhood Experiences (ACEs) and early exposure to illicit drug use. Shared life events resulting in their initiating and sustaining an OUD involved continuous hardship into adulthood, mental illness and concurrent benzodiazepine use disorder, often resulting in harrowing accounts of participants' loneliness and lack of life purpose. Their living environments, an erroneous understanding of their illness and poor communication with allied health professionals further perpetuated their OUD. Positive factors influencing periods of abstinence were familial incentives and a belief in the efficacy of methadone. Clients own suggestions for improving their journeys included employing a multi-sectorial approach to managing OUD and educating themselves and others on opioid agonist treatments. If clients were not progressing appropriately, they themselves suggested enforcing a 'time-limit' on clients to engage with the programme or indeed for their treatment to be postponed. Conclusions: To optimise the functioning of the MMTP, three tasks need to be fulfilled: 1) Reduce the incidences of ACEs, 2) Diagnose and treat clients with a dual diagnosis 3) Educate clients, their families, the public and allied health care professionals on all aspects of OUD. A cross-departmental, inter-governmental approach is needed to address opioid misuse as a societal issue as a whole.

Objectives: To determine the prevalence of endometriosis among adolescent school girls with severe dysmenorrhea. Methodology: Data was collected via interviewed questionnaire. Patients with symptoms and signs suggestive of endometriosis were further evaluated by abdominal ultrasonography (AUS), serum cancer antigen 125 (CA125). Laparoscopy was done for confirmation in those who agreed. Those who declined laparoscopy were offered magnetic resonance imaging (MRI). Results: A total number of 654 adolescents were interviewed. Their mean age was 15.2 ±3.53 SD years. The mean duration of cycles and flow days was 29 ± 8.4 SD and 4 ± 2.8 SD respectively. The age of menarche in years was 13 ± 1.2 SD. Cycles were regular in 77.4 % (n=506) while irregular in 22.6 % (n=148). Of all studied girls, 48.9% (n=320) had menstrual pain of varying degree of severity. Severe dysmenorrhea was reported in 68.8 % (n=220/320) of them. Fifty six of these cases (25.5 %) had ultrasound findings suggestive of endometriosis. CA125 was elevated in41.5 % (n= 27/56) of them. Patients accepted laparoscopic confirmations were 34, of them 79.4%, (n=27) had positive histo-pathological evidence of endometriosis. MRI was offered to those declined laparoscopy (n=22). Endometriosis was suggested in 77.3% of them. The study concluded the prevalence of endometriosis in adolescents with severe dysmenorrhea was 12.3 % despite some declined laparoscopy. The unacceptability of laparoscopy and unfeasibility of local examination and trans-vaginal ultrasound add more to the difficulty of diagnosis.

To asses the efficacy of commercially available tests device method for anti HCV detection. Total 2000 blood samples for detection of anti HCV were screened initially by immunochromatographic method. Those found positive on initial screening were re-tested by ELISA method at the Biochemistry Laboratory of the Pakistan Medical Research Council, Fatima Jinnah Medical College, Lahore. Out of a total of 2,000 blood samples, 177 were found to be initially reactive/positive for anti-HCV with immunochromatographic method. When these reactive/positive samples were retested for confirmation with ELISA, 47 blood samples were found to have tested falsely positive for anti-HCV. Overall 2.35% of blood samples were found to be tested false positive for anti-HCV by immunochromatographic device method. Immunochromatographic device method test is rapid and simple, which can be used in setting with limited facility when rapid testing is required. However it should not be used as sole criteria for dia...

BACKGROUND There are many risk factors besides age and immune suppression for herpes zoster. Family history as a risk factor is suggested in some recent studies. The aim of this study was to evaluate the association between herpes zoster and family history. METHODS This case-control study was undertaken in Farshchian Hospital, Hamadan, Iran. &quot;Case group&quot; included patients with confirmed diagnosis of herpes zoster. &quot;Control group&quot; was chosen among other dermatologic patients or their companions without any history of herpes zoster. Immune deficiency was the main excluding criteria. Information about age, gender, dermatome involved (only in patient group), history of chronic dermatologic or systemic diseases and family history of herpes zoster was asked using special questionnaires. RESULTS Case and control groups included 217 and 200 participants respectively. Mean age of cases and controls was 49.08±15.59 and 49.96±15.54 years old respectively (P=0.936). 53.5% of...

Background: Cardiac Autonomic Neuropathy (CAN) is one of Type 1 Diabetes Mellitus complications with a high mortality rate. This condition might occur right after T1DM is diagnosed but is often asymptomatic. Cardiac Autonomic Reflex Tests (CART's) are one of the gold standard, non-invasive diagnostic with high sensitivity used for screening but rarely used in children. Some risk factors are associated with CAN, and one of them is poor glycemic Control. Objective: To delineate risk factors associated with Cardiac Autonomic Neuropathy in children with Type 1 Diabetes Mellitus at Dr. M Jamil Padang Hospital. Methods: A diagnostic test study was performed on children aged under 18 years old who came to the outpatient pediatric endocrinology clinic of M. Djamil Hospital or Pediatric Ward between February till August 2022 whom caregivers agreed to sign in the informed consent and follow instructions to do one of CART's maneuver called Heart Beat to Deep Breathing with ECG and draw a level HbA1C as Glycemic Control. Secondary data was collected from medical records. Data analysis was performed with a 2x2 table using a computer program Result: 34 samples were collected, with mean age T1DM 13,14±2,75 years and mean age at onset 10,4±2,65 years. CAN was diagnosed in 13 (38,2%) T1DM subjects and there was no signification between onset at age (p=1,0), duration of illness (p=0,653), and Glycemic control (p=0,132). Conclusion: No significant correlation was found between risk factors associated with Cardiac Autonomic Neuropathy in Type 1 Diabetes Mellitus.

Introduction: Prediction of complications is an essential part of risk management in surgery. Knowing which patient to operate and those at high risk of developing complications contributes significantly to the quality of surgical care and cost reduction. The postoperative complications of patients who underwent Laparotomy in Mulago Hospital were studied using POSSUM scoring system. The main objective of this study was to determine the postoperative complications of Laparotomy in Mulago Hospital, between September 2003 and February 2004. Methods: Consecutive patients, who underwent Laparotomy in Mulago, were studied using POSSUM system for development of complications. For each patient operated, they were followed up in wards until discharge. When the postoperative complications were reported, they were reexamined by the surgeons, treated and followed up for 30 days postoperatively. Phone contacts were used for the follow up. Surgical reviews were conducted once a week in Mulago Hos...

This is an important volume, containing contributions by an outstanding group of authors on some of the central issues of the Doha agenda negotiations. Distinguishing features of the volume include its comprehensive coverage of the issues, and the way the authors explain them in comprehensible terms, covering both the historical context and the debates currently raging in the WTO. ' -Will Martin,The World Bank, US Agricultural Policy Reform and the WTO provides insights into the effects of the Uruguay Round WTO agreement on agricultural policy and global markets, and considers what is at stake in the Doha Development Agenda Round.

The purpose of this study was to estimate the need for population-level services for alcohol and other drug abuse in support of local planning. Method: Data were drawn from a subsample of 2,942 interviewees from the São Paulo Megacity Study, which evaluated mental health in the general population (18 years and older) of residents in the São Paulo metropolitan area. This population was classified into fi ve hierarchical categories of severity, making it possible to obtain estimates of need for services, combining evaluation criteria regarding drug and alcohol use and general and mental health comorbidities over the last 12 months. For the at-risk groups in this population, estimates from the Potential Demand for the Use of Services survey interviews over the last year were generated. Results: Concerning the need for services, 86.5% of the population (Tier 1) had no problems related to drug and alcohol use, 8.9% (Tier 2) used heavily, 3.5% (Tiers 3, 4, and 5) met criteria for substance abuse disorders, among whom 1.3% (Tiers 4 and 5) require more specialized and intensive treatment and support. The following estimates for the Potential Demand for the Use of Services were found: 25.5% (Tier 3) and 51.1% (Tier 4), indicating that a signifi cant number of individuals met criteria for substance abuse disorders but did not perceive any need for professional help or neglected the help available. Conclusions: In São Paulo there exists a large sector of the population that requires prevention strategies regarding the risks and harm resulting from alcohol and drug use, followed by a group requiring more specialized care. But a large number of substance users requiring specialized support did not use services and did not believe that they needed professional help. (J. Stud. Alcohol Drugs, Supplement 18, 87-95, 2019) RÉSUMÉ. Objectif : Estimer le besoin de la population en termes de services pour l'abus d'alcool et d'autres drogues de façon à soutenir la planification locale. Méthode : Les données proviennent d'un sous-échantillon de 2 942 personnes interrogées dans le cadre de l'Étude sur la mégapole de São Paulo évaluant la santé mentale de la population générale (18 ans et plus) résidant dans la région métropolitaine. Cette population a été classée en cinq catégories hiérarchiques de sévérité, permettant ainsi d'obtenir des estimations de besoins de services, combinant les critères d'évaluation de l'usage d'alcool et de drogues et les comorbidités générales et de santé mentale au cours des 12 derniers mois. Les estimations de l'utilisation de services et des besoins perçus de services, au cours de la dernière année, ont été produites pour les groupes à risque de cette population. Résultats : Concernant le besoin de services, 86,5% de la population (catégorie 1) n'ont aucun problème relié à leur consommation d'alcool et de drogue, 8,9%(catégorie 2) consomment beaucoup, 3,5% (catégorie 3, 4 et 5) présentent les critères diagnostics du trouble de l'utilisation de substances, parmi lesquels 1,3% (catégorie 4 et 5) nécessitent du soutien ainsi qu'un traitement spécialisé et intensif. Les estimations suivantes pour l'utilisation de services/besoins perçus ont été calculées, 25,5 % (catégorie 3) et 51,1% (catégorie 4), indiquant qu'un nombre significatif d'individus présentent les critères diagnostic du trouble d'utilisation de substances mais ne ressentent pas le besoin de recevoir une aide professionnelle ou négligeraient celle qui est disponible. Conclusion : La mise en place de stratégies d'amélioration des options thérapeutiques, de la disponibilité des traitements et du soutien, ainsi qu'un plan de sensibilisation aux dangers de la toxicomanie devraient être des priorités. Estimar la necesidad de servicios a nivel de población para el abuso de alcohol y otras drogas en apoyo de la planificación local. Método: Los datos se obtuvieron de una submuestra de 2,942 entrevistados del Estudio de Megaciudades de São Paulo que evaluó la salud mental en la población general (18 años y más) de residentes en el área metropolitana de São Paulo. Esta población se clasificó en cinco categorías jerárquicas de gravedad, lo que permite obtener estimaciones de la necesidad de servicios, combinando los criterios de evaluación con respecto al uso de drogas y alcohol y las comorbilidades generales y de salud mental en los últimos 12 meses. Para los grupos en riesgo de esta población, se generaron estimaciones para el uso de servicios / necesidad de uso percibida durante el último año. Resultados: Con respecto a la necesidad de servicios, 86,5% de la población (categoría 1) no tuvo problemas relacionados con la droga y el uso de alcohol, 8,9% (categoría 2) que se utilizan en gran medida, 3,5% (categorías 3, 4 y 5) cumplió los criterios para los trastornos por abuso de sustancias, entre los cuales el 1.3% (categorías 4 y 5) requieren un tratamiento y apoyo más especializado e intensivo. Se encontraron las siguientes estimaciones de Uso de servicios / Necesidad de uso percibida, 25.5% (categoría 3) y 51.1% (categoría 4) que indica que un número signifi cativo de personas cumplieron los criterios para trastornos por abuso de sustancias, pero no perciben ninguna necesidad de ayuda profesional o descuidan la ayuda disponible. Conclusiones: Las estrategias para aumentar los conocimientos sobre los peligros del abuso de sustancias, y mejorar las opciones de cuidado y la disponibilidad de tratamiento y el apoyo deben hacerse prioridades.

Plasma melatonin circadian profiles were in- vestigated in a group of 4 patients with anorexia nervosa and 4 healthy regularly cycling women. There were no differences in the mean age of both groups, whereas the anorexia nervosa patients had lower mean body weight (37.8 \ m=+-\ 2.0 vs 57.0 \ m=+-\ 4.9 kg) and body mass index (13.9 \m=+-\ 1. 1 vs 20.8 \ m=+-\2.0). Samples were collected every 2 h and plasma melatonin was measured by using a RIA with an iodinated tracer. Anorexia nervosa patients exhibited higher diurnal (60.7 \ m=+-\ 1.8 vs 25.4 \ m=+-\ 1.72 pmol/l, P< 0.02) and nocturnal (419.2 \ m=+-\37.4 vs 108.0 \ m=+-\ 33.6 pmol/l), P< 0.001) mean plasma melatonin concentrations. There were no differences in the time peak for nocturnal mela- tonin secretion in both groups, detected at 02.00 h. In an- orexia nervosa, the melatonin circadian profile paral- leled that observed in the control group, indicating that the increased melatonin values for anorexia nervosa were probably due to an enhanced secretory pineal func- tion rather than an impaired melatonin metabolism. These results suggest a participation of the pineal gland in the pathophysiology of anorexia nervosa. Anorexia nervosa is a psychoneuroendocrine dis¬ ease characterized by an isolated hypogonadotropic hypogonadism (Boyar et al. 1974; Halmi &

Objectives: There is no single “correct” definition of poverty. However, there is consensus that any definition of poverty needs to acknowledge particular social, economic and cultural contexts. Different meanings of poverty results in different policy implementations in the context of human poverty. There is also less agreement as to whether objective or subjective definitions and measurements of poverty are more valid. Participatory approaches however point to the need to let people define for themselves what it means to be poor and define the magnitude, causes and consequences of being poor. The major focus of this paper was to clarify, explain and define the

Финансиската криза од 2007 година е најлошата економска појава по „Големата депресија“(1929). Илјадници луѓе ги загубија своите заштеди, работни места, а некои и своите домови и животи. Потребата од анализирање на причинителите за оваа појава е повеќе од евидентна, со цел учење од минатото и избегнување на слични кризи во иднина. За правилно да разбереме што се случи, истражувањето е потребно да го започнеме со проучување на основните фактори кои ја предизвикаа кризата. Станува збор за низа погрешно донесени одлуки како резултат на постоењето на асиметрични информации, пропратени со неправилности во менаџментот на ризик. Асиметричните информации, односно неповолната селекција и пред сѐ, моралниот хазард се наоѓаат во самиот фундамент на финансиската криза. Моралниот хазард ни ја претставува можноста за преземање на ризик во поголема мера од она што е нормално, притоа знаејќи дека евентуалните штети би ги претрпел некој друг. Така, миксот помеѓу дерегулацијата, високата концентрациј...

Many young people are beginning to feel isolated because of their mental and emotional decline. Perceptions of mental health can encapsulate a person’s ability to enjoy life and find a balance between health activities and efforts to achieve mental resilience. Mental health is a symptom of emotions and shows effective adaptation to a host of needs. From this perspective, this study was conducted to find ways and means of maintaining mental health among urban youth. The major objectives to conduct this study were to identify the means through which urban adolescents achieve their good mental health and to identify the impact of adolescent’s mental health on quality of life and school performance. Students of 11, 12 and first year bachelors’ were taken as sample. Descriptive method was conducted to find out the results and SPSS technique was used to analyze data. It was seen that many adolescents show common traits os stress and apply common means and strategies to cope their anxiety.

Current literature lacks systematic data on acute perioperative pain management in neonates and mainly focuses only on procedural pain management. In the current review, the neurophysiological basis of neonatal pain perception and the role of different analgesic drugs and techniques in perioperative pain management in neonates are systematically reviewed. Intravenous opioids such as morphine or fentanyl as either intermittent bolus or continuous infusion remain the most common modality for the treatment of perioperative pain. Paracetamol has a promising role in decreasing opioid requirement. However, routine use of ketorolac or other nonsteroidal anti-inflammatory drugs is not usually recommended. Epidural analgesia is safe in experienced hands and provides several benefits over systemic opioids such as early extubation and early return of bowel function.

Program baru pemerintah pusat lewat kementerian Kesehatan (Kemenkes) memberikan jaminan sosial kesehatan bagi masyarakat melalui Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS. Masalah yang sering di jumpai pada pengguna BPJS adalah keluhan pelayanan keperawatan yang diberikan oleh petugas kesehatan tidak semuanya tanpa biaya. Pelayanan yang diberikan oleh petugas kesehatan cenderung tidak memenuhi kepuasan pasien. Tujuan penelitian ini adalah untuk mengetahui tingkat kepuasan pasien BPJS dalam pelayanan keperawatan di Ruang Rawat Inap Mawar  RSUD Dr. Hardjono Ponorogo.       Desain penelitian ini adalah deskiptif. Responden penelitian ini adalah pasien BPJS di RSUD Dr.Hardjono Ponorogo. Teknik sampling penelitian menggunakan Proposive Sampling. Sampel penelitian ini adalah sebagian pasien yang di rawat di ruang rawat inap  mawar di RSUD Dr.Hardjono Ponorogo dengan jumlah 48 responden. Pengumpulan data menggunakan kuisioner sedangkan teknik analisa data menggunakan prosentase.  ...

The fabrication process used for Nb3Sn accelerator magnets comprises coil reaction at high temperature and then impregnation with epoxy to restore the insulation electrical and mechanical properties. The traditional epoxy has a low radiation strength which limits the lifetime of accelerator magnets operating in severe radiation environments. Fermilab performs studies of Matrimid® 5292 - a bismaleimide based material, as a radiation-resistant alternative to epoxy. This material has appropriate viscosity and pot life, and provides excellent mechanical, electrical and thermal coil properties. Two Nb3Sn coils, a 1 m long quadrupole coil and a 2 m long dipole coil, were fabricated and impregnated with Matrimid. The quadrupole coil was tested in a quadrupole mirror at 4.5 and 1.9 K. Coil test results are presented and compared to similar coils impregnated with epoxy.

Patients coming to their family physician (FP) usually have more than one condition or problem. Multimorbidity as well as dealing with it, is challenging for FPs even as a mere concept. The World Health Organization (WHO) has simply defined multimorbidity as two or more chronic conditions existing in one patient. However, this definition seems inadequate for a holistic approach to patient care within Family Medicine. Using systematic literature review the European General Practitioners Research Network (EGPRN) developed a comprehensive definition of multimorbidity. For practical and wider use, this definition had to be translated into other languages, including Croatian. Here presented is the Croatian translation of this comprehensive definition using a Delphi consensus procedure for forward/backward translation. 23 expert FPs fluent in English were asked to rank the translation from 1 (absolutely disagreeable) to 9 (fully agreeable) and to explain each score under 7. It was previou...

To assess patient-reported outcomes, including frequency of nighttime heartburn symptoms, level of discomfort with nighttime heartburn symptoms, and quality of sleep, in patients with gastroesophageal reflux disease (GERD). Methods: Randomized, double-blind, baseline-controlled, two-period, two-treatment crossover study. Placebo was administered during baseline pH measurements. Patients were then randomly assigned to one of the following sequences: pantoprazole/ranitidine (nϭ12) or ranitidine/pantoprazole (nϭ19). Patients underwent two 8-day, double-blind treatment periods (pantoprazole 40 mg once daily or ranitidine 150 mg twice daily) separated by at least a 10-day (up to 21-day) washout period. Patients recorded frequency of nighttime heartburn symptoms (number of episodes per day), level of discomfort (1ϭnone to 7ϭvery severe) with nighttime heartburn symptoms, and sleep quality (1ϭexcellent to 7ϭextremely poor) using daily diaries. Differences between pantoprazole and ranitidine were compared using two-sample t-test or nonparametric Wilcoxon test as appropriate. A P-value Ͻ 0.05 in a two-tailed test was considered significant. Results: On day 1 and 8 during the nighttime (10 pm-8 am) period, the percentage of time that pH was 4 or higher was significantly greater with pantoprazole versus ranitidine (PՅ0.004 and PՅ0.007, respectively). Regardless of period: the frequency of nighttime heartburn symptoms was 0.17Ϯ0.37 for pantoprazole versus 0.50Ϯ0.55 for ranitidine (PϽ0.01), the level of discomfort with nighttime heartburn symptoms was 1.20Ϯ0.36 for pantoprazole versus 1.62Ϯ0.64 for ranitidine (PϽ0.01), and the quality of sleep was 2.76Ϯ0.66 for pantoprazole versus 2.94Ϯ0.59 for ranitidine (PϽ0.05). Conclusions: Pantoprazole has a significantly positive impact on patientreported outcomes including frequency of nighttime heartburn symptoms, level of discomfort with nighttime heartburn symptoms, and quality of sleep, in patients with GERD.

BackgroundVarying degrees of cortical amyloid deposition are reported in the setting of Parkinsonism with cognitive impairment. We performed a systematic review to estimate the prevalence of Alzheimer disease (AD) range cortical amyloid deposition among patients with Parkinson&#39;s disease with dementia (PDD), Parkinson&#39;s disease with mild cognitive impairment (PD‐MCI) and dementia with Lewy bodies (DLB). We included amyloid positron emission tomography (PET) imaging studies using Pittsburgh Compound B (PiB).MethodsWe searched the databases Ovid MEDLINE, PubMed, Embase, Scopus, and Web of Science for articles pertaining to amyloid imaging in Parkinsonism and impaired cognition. We identified 11 articles using PiB imaging to quantify cortical amyloid. We used the metan module in Stata, version 11.0, to calculate point prevalence estimates of patients with “PiB‐positive” studies, that is, patients showing AD range cortical Aβ‐amyloid deposition. Heterogeneity was assessed. A scat...

Reliable biomarkers for amyotrophic lateral sclerosis (ALS) are needed, given the clinical heterogeneity of the disease. Here, we provide proof-of-concept for using multimodal magnetic resonance imaging (MRI) as a diagnostic biomarker for ALS. Specifically, we evaluated the added diagnostic utility of proton magnetic resonance spectroscopy (MRS) to diffusion tensor imaging (DTI). Twenty-nine patients with ALS and 30 age- and gender-matched healthy controls underwent brain MRI which used proton MRS including spectral editing techniques to measure γ-aminobutyric acid (GABA) and DTI to measure fractional anisotropy of the corticospinal tract. Data were analyzed using logistic regression, t-tests, and generalized linear models with leave-one-out analysis to generate and compare the resulting receiver operating characteristic (ROC) curves. The diagnostic accuracy is significantly improved when the MRS data were combined with the DTI data as compared to the DTI data only (area under the R...

Welcome to our annual report on the state of the Academic Health Center . I'd like to welcome our colleagues on the St. Paul and Duluth campuses as well--we're using a new technology today, Breeze, that allows colleagues across town and across the state to see what's going on here, and send questions. Before I move into my reflection on the year past, and plans for the future, I'd like to ask all of you a couple of questions: 1. Does it feel to you that you're working harder than you can ever remember working? As if the volume and pace are simply magnified? 2. And, is that sense leading to a certain tension for you here at the University and in the workplace? If so, welcome to America in 2004. We're hearing from national experts who monitor our attitudes who tell us this country is in what's called a hinge period, or a period of time between defined eras. Whenever that happens--when we're between eras we understand and can define comfortably--we experience all of the symptoms of change ; the transitions and the extremes that come before a new period of consensus. These effects move well beyond the University and our workplace--they're being felt in our social lives and certainl y in our political lives. Of course, within the health professions, we don't need national pollsters to tel l us that we're within a period of change. We experience the effects or impact of change nearly every day. In fact, most of us now recognize that the core of our professions require change--that what we know as fact today will be challenged by new knowledge--and that new knowledge wi ll transform the status quo. In our research labs, we seek that change--those breakthroughs that will improve our ability to care for our pa tients and improve the health of our communities. Just this week on campus, our Lillehei Heart Institute hosted a remarkable group of cardiovascular pioneers who were committed to changing the status quo of their era. Remember that it was just 50 years ago that an infant born with a hole in the heart was slated to die of that defect. That simply wasn't acceptable to the cardiovascular surgeons of the early 1950s--so they led the quest for change. And this week, we celebrated the 50 th anniversary of open heart surgery by cross circulation--a pr ocedure that made a hole in the heart just something to repair. Today--we are facing holes in the fabric of health care that call for pioneering changes beyond the scope of the most skilled of surgeons. The holes I'm referring to will require engagement from all the health professions that are at the core of this great research University--and will require those professions to work together to pioneer solutions. There is a signi ficant gap in our understanding of the connections between animal and human health. We have continuing gaps in our ability to predict and re spond to the health professional needs of our communities. And those gaps or holes lead to significant consequences in access to health care , the safety and quality of that care, and to efforts to engage patients and health care consumers in owning their own health.

Simons a framework of levers controls revealed that effective use and control of the management system (MCS) can significantly contribute to increased financial performance as well as operational performance. However, the main objective and aim of this research study are to evaluate the financial performance of SME firms in Thailand through the role of the effective use of management control systems. This research paper also examines the direct relationship between MCS and the financial performance of the sector. The research model of this study also investigates the mediating role of product and process innovation in improving the relationship between the financial performance of the sector and MCS. To find the impact of MCS on the firm performance this study collects most of the data from selected employees and managers of different SME firms of Thailand with the help of the survey questionnaire. The results that are calculated with the help of structural equation modeling indicate that MCS significantly influence the financial performance of the firm and also made a significant contribution in enhancing the operational performance of the sector. Furthermore, the findings of this study also demonstrate that product innovation improves the relationship between MCS and financial performance. Accepted hypotheses of this 150 research help many future analysts to understand the importance of MCS.